Banned in America, peddled in Africa

Even in some of the far-flung rural hamlets of Africa, women know the name. "Depo," as they call a drug tradenamed "Depo-Provera," is becoming increasingly popular across the continent, as African nations struggle to bring spiraling population growth under control.

In some countries, Depo is already the most popular form of contraceptive. Yet the use of the drug as a contraceptive is prohibited in the United States. Its widespread use in Africa and other underdeveloped countries, according to some critics, raises the question of whether an unsafe drug is being peddled to a largely illiterate and uneducated public.

Depo differs from most other contraceptive drugs in that it is injectable; one "shot" can prevent pregnancy for three months. That is an attractive selling point among rural black African women, for whom repeated trips to a family-planning clinic are difficult, costly, and time- consuming.

The drug is also easier to use than most other forms of contraceptive, and is considered highly effective in preventing pregnancy.

Yet critics point to tests suggesting that Depo-Provera induces tumors in dogs and cancer in monkeys. The tests are controversial, because the research animals received much larger doses of the drugs than would normally be administered to humans. And some authorities question whether results of the animal testing can rightly be applied to humans.

However, other tests suggest that two forms of cancer seem to be more common among Depo-Provera users than among the general population. Defenders of the drug attribute this to more medical by Depo users, resulting in more detection -- though not necessarily more disease -- among them.

In some countries, double doses of the drug are administered to prolong its contraceptive action -- a practice not recommended by the manufacturer.

That manufacturer -- the American-based Upjohn Company -- concedes that Depo is transmitted to infants through the mother's milk, but says there is no known short-term effect on the children. But Daniel Zeeman, medical adviser to Upjohn's South African subsidiary, concedes, "There's not enough hard data at this point in time to eliminate all the long-term concerns."

The US government not only prohibits use of the drug for birth control in the US, but also bans its export. Officials try to ensure that American foreign aid money is not used to purchase or dispense Depo abroad.

Upjohn, however, markets Depo in some 80 countries, supplying many of them from a large manufacturing plant in Belgium.

R. S. Haines, an Upjohn executive in South Africa, says the company has "no problems at all" in marketing the drug "save the problems that are created by the pressure groups."

These include several women's organizations and Ralph Nader's health research group. The United Nations World Health Organization, however, places no special restrictions on the drug.

But some experts say more research is needed to clear up continuing concern over Depo-Provera.

"What we don't understand," says one woman in Kenya, where the drug is used extensively, "is why they don't use this drug in places where it was first produced -- places like America."

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